Growing old with HIV

It's hard enough dealing with the aches and pains that usually come with getting older, but when you're HIV-positive, ageing brings more chronic illnesses and even more medication; many health systems are not ready to cope with this relatively new phenomenon.

Data on ageing with HIV is largely restricted to the developed world and very little is known about older Africans living with virus, despite the high caseload in this region. A July 2012 supplement of the medical journal, AIDS, notes that an estimated 3 million people in sub-Saharan Africa aged 50 and older are HIV-positive - 14 percent of all infected adults.

Joel Negin, a researcher at the University of Sydney School of Public Health and one of the supplement’s co-authors, said this was because most demographic and health surveys use 49 years as their endpoint for data collection. Speaking at the 19th International AIDS Conference in Washington DC on 25 July, Negin warned that the global research and policy community could no longer afford to neglect this older age group.

Old but not cold

"We need to start talking about [the fact that] sex doesn’t end at 50 and address [our] ageist assumptions about sexual behaviour," he said. Older adults accounted for 15 percent of new cases of HIV in the United States in 2005. The South African government has included men over 50 as one of the most at-risk populations after the latest national HIV prevalence survey revealed that infection among men and women aged between 50 and 60 was over 8 percent - higher than among men in the 20-24 age group.

"The thinking is that women over 50 are not able to engage sexually and don't have feelings. I'm still sexually active, and of course other women are… When you go to a clinic, especially in the rural areas… you are seen as a grandmother… The healthcare provider is wondering what is happening to this granny, why would she be coming to the clinic for an STI [sexually transmitted infection] or a condom because you are supposed to have stopped having sex at that age," said 55-year-old Dorothy Onyango, the executive director of Women Fighting AIDS in Kenya (WOFAK).

Nils Daulaire, the director of the Office of Global Health Affairs in the United States Department of Health and Human Services, said not only do older people still have sex, but it is mostly not safe sex and is frequently with multiple partners. As a result of being left out of HIV awareness campaigns, older people often did not know enough about HIV and preventing it.

"Not for sissies"

HIV-positive people may also be at greater risk of certain illnesses associated with old age - studies suggest they may contract them sooner - but health systems in developing countries are still grappling with the burden of HIV/AIDS and are not equipped to deal with this added dimension.

A higher number of bone fractures and osteoporosis, a dramatic rise in the risk of hypertension and cardiovascular disease, as well as higher levels of depression, suicide and frailty are some of the long list of ailments that confront older adults living with the virus.

The thinking is that women over 50 are not able to engage sexually and don't have feelings... you are seen as a grandmother

"It's so early in the research that it's very hard to separate which of these problems are associated with side effects from medication - not just antiretrovirals (ARVs) but other medicines that HIV patients may be taking - or which are direct biological effects of the virus itself over time, and are due to the misalignment of the immune system," said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, a think-tank. "Ageing - it ain’t for sissies," she added.

In the developed world, worries about money, increasing ill-health and feelings of loneliness or isolation are common among older people with HIV. John Hock, an Australian activist who has been living with HIV for over 30 years, said those diagnosed at the start of the epidemic may have been forced to give up work due to ill health, and many stopped making provision for old age because they did not expect to live that long.

Money is an even greater concern for older Africans living with the virus. Ruth Wayeru, now 65, was diagnosed with HIV when she was 48; in her home country of Kenya, only first- and second-line ARVs are freely available.

Wayeru told delegates that "Once the second-line says 'no' to your body, there is nothing else to do but start arranging your funeral," because the cost of third-line medicines is prohibitive and out of reach for pensioners.